An integrated specialized AF-Clinic reduced all-cause mortality compared with usual care (3.7% vs 8.1%; HR 0.44; 95% CI 0.23-0.85; P=0.014).
RCT (n=712)
Open Blinded Endpoint
Randomized
No
Does an integrated specialized AF-Clinic reduce all-cause mortality in patients with newly diagnosed atrial fibrillation?
Nurse-driven, physician-supervised integrated care clinics for newly diagnosed atrial fibrillation significantly reduce all-cause and cardiovascular mortality compared to usual cardiologist care.
Effect estimate: HR 0.44 (95% CI 0.23-0.85)
Absolute Event Rate: 3.7% vs 8.1%
p-value: p=0.014
AIMS: An integrated chronic care programme in terms of a specialized outpatient clinic for patients with atrial fibrillation (AF), has demonstrated improved clinical outcomes. The aim of this study is to assess all-cause mortality in patients in whom AF management was delivered through a specialized outpatient clinic offering an integrated chronic care programme. METHODS AND RESULTS: Post hoc analysis of a Prospective Randomized Open Blinded Endpoint Clinical trial to assess all-cause mortality in AF patients. The study included 712 patients with newly diagnosed AF, who were referred for AF management to the outpatient service of a University hospital. In the specialized outpatient clinic (AF-Clinic), comprehensive, multidisciplinary, and patient-centred AF care was provided, i.e. nurse-driven, physician supervised AF treatment guided by software based on the latest guidelines. The control group received usual care by a cardiologist in the regular outpatient setting.After a mean follow-up of 22 months, all-cause mortality amounted 3.7% (13 patients) in the AF-Clinic arm and 8.1% (29 patients) in usual care hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.23-0.85; P = 0.014. This included cardiovascular mortality in 4 AF-Clinic patients (1.1%) and 14 patients (3.9%) in usual care (HR 0.28; 95% CI 0.09-0.85; P = 0.025). Further, 9 patients (2.5%) died in the AF-Clinic arm due to a non-cardiovascular reason and 15 patients (4.2%) in the usual care arm (HR 0.59; 95% CI 0.26-1.34; P = 0.206). CONCLUSION: An integrated specialized AF-Clinic reduces all-cause mortality compared with usual care. These findings provide compelling evidence that an integrated approach should be widely implemented in AF management.
Hendriks et al. (Tue,) conducted a rct in Atrial fibrillation (n=712). Integrated specialized AF-Clinic vs. Usual care was evaluated on All-cause mortality (HR 0.44, 95% CI 0.23-0.85, p=0.014). An integrated specialized AF-Clinic reduced all-cause mortality compared with usual care (3.7% vs 8.1%; HR 0.44; 95% CI 0.23-0.85; P=0.014).